Background: In 2011, Stellenbosch University introduced a district hospital-based longitudinal integrated model for final-year students as part of its rural clinical school. The present study is an analysis of students’ experiences during the first 3 years of the programme.

Methods: All 13 students who started the programme between 2011 and 2013 were interviewed. Thematic networks linking recurrent issues were developed and transcripts were analysed against this framework using ATLAS.ti.

Results: Two major themes emerged. These were ‘preparation for being a doctor’ and ‘academic/exam preparation’. Students were overwhelmingly positive about the working atmosphere and their preparation for clinical practice and felt that their learning had been facilitated by the flexibility of the programme and the requirement to take responsibility. This contrasted with their academic (‘book’) learning, which was characterised by uncertainty about expectations, particularly regarding exams and parity with learning at the central teaching hospital. The flexibility of the integrated approach was seen as a problematic lack of structure when it came to academic learning. Negative academic emotions were compounded by some frustration about administrative issues early in the programme.

Conclusions: The district hospital-based longitudinal integrated model has great potential as a teaching platform for final-year students; however, students remain concerned about academic learning. Potential strategies to reduce student anxiety include more opportunities for dialogue between rural students and specialist teaching platforms, clearly communicated expectations – both about what the students can expect from the programme and about what is expected from them – and administrative excellence.